Abstract
Background and objectives: Endotracheal intubation is one of the most important procedures in Pediatric Intensive Care Unit (PICU ) for maintaining the patency of airways and applying Positive Pressure Ventilation (PPV), however, it is always temporary and needs a logic decision for termination (extubation) at a proper situation either to restore the physiologic respiration or to avoid imposing the risk of recurring respiratory failure.
There are several risk factors for extubation failure including: occlusion of air ways by hypersecretion, ineffective cough reflex, central nervous system (CNS) dysfunction and etc. We planned to study these risk factors.
Methods and Materials: In an Analytical cross–sectional study, from January 2003 to August 2005 the risk factors of reintubation in two groups of patients compared, both groups consisted of 30 children , one with successful extubation and another with extubation failure. In each group, age, gender, underlying disorder, duration of mechanical ventilation before extubation and the results of blood gas analysis before each intubation and extubation were recorded, the results were statistically analyzed by T-test and X2(chi-square).
Results: This study showed that neuromuscular disorders (including: spinal muscular atrophy, Guillain-Barre syndrome, muscular dystrophies and congenital myopathies) are the main underlying disease in extubation–failure group (P= 0.0002).
Besides, in comparison between two group of patients–who had successful versus failed extubation, hypercapnia (PaCO2>50mmHg) was showed to be the most common cause of both the first intubation (P=0.001) and reintubation (P=0.004) in patients who failed extubation.
conclusion: This study shows that neuromuscular disorders are the most common causes which defeat weaning from ventilator or result in reintubation by induction of hypercapnia. Therefore the weaning process must be done gradually in these patients, and conjoined with supportive measures such as close observation at least for 72 hours after extubation, watching recurrence of hypercapnic respiratory failure.